Testing key to slowing growth of sexually transmitted infections in Lane County

By Suzanne Adams-Ockrassa The Register-Guard

Wednesday

Dec 12, 2018 at 7:01 AM

New, faster tests that take minutes instead of days, such as one being developed for chlamydia, could help in the fight against the growing number of sexually transmitted infections — nationwide and locally — by providing patients with a diagnosis and access to treatment in the same day.

But, first, doctors have to get patients in the door.

“It’s uncomfortable for the doctor and the patient, but we need to do a better job encouraging doctors and nurses to ask for a sexual history,” said Dr. Patrick Luedtke, Lane County’s Senior Public Health officer. “We need to empower patients to share their sexual history with their provider.”

Cases of sexually transmitted infections such as chlamydia, gonorrhea and syphilis have been on the rise in since the early 2000s, and health officials are predicting the number of cases will continue to increase in 2019 because people aren’t practicing safe sex. Untreated sexually transmitted infections can lead to long-term health problems for men and women and to birth defects in babies. But early testing and treatment can cure an infection and prevent new infections.

Nationwide, chlamydia cases rose 22 percent between 2013 and 2017. Over the same time period there was a 67 percent increase in cases of gonorrhea and a 76 percent increase in cases of syphilis, according to the U.S. Centers for Disease Control and Prevention. Oregon has seen a similar increase in STI cases over the past decade. For example, cases of chlamydia statewide nearly doubled — from 9,861 in 2007 to 18,634 in 2017. Other STIs saw equally significant increases including gonorrhea, which rose from 1,239 cases in 2007 to 5,022 in 2017, and syphilis which climbed from 26 to 352 cases over the same time period.

Lane County started seeing an increase in cases around 2015, Luedtke said. The county went from hundreds to thousands of cases of chlamydia, tens to hundreds of cases gonorrhea and single digits to tens of cases of syphilis.

In 2016, the latest data available for Lane County, the number of chlamydia cases nearly doubled from 849 in 2007 to 1,621. Gonorrhea increased from 53 in 2007 to 281 cases in 2016 and syphilis increased from two cases to 14 over the same time period.

Doctors say many factors may be behind the rise in STIs but there is one constant contributing factor: New, aggressive treatments for human immunodeficiency virus (HIV) may be contributing to people no longer being fearful of getting a STI. As a result, they aren't using condoms when having sex. Condoms are very effective against STIs such as HIV, chlamydia, gonorrhea and trichomoniasis, according to the CDC. Condoms may reduce the risk of genital herpes, syphilis and genital warts if they cover the area where a wart or ulcer is located.

"Since HIV has been less of a concern we have seen less condom use," said Dr. Tim Menza, Oregon Health Authority HIV/STD/TB section medical director.

A closer look at the numbers

The data also reveal more women are testing positive for STIs. For example, over the past decade 9,363 women and 4,164 men in Lane County contracted chlamydia. This may be because women are more likely to go to the doctor than men, Luedtke said.

Women also are more likely to be tested on a regular basis, he said. Women who keep up with their annual gynecological exam are more likely to be tested and when a woman gets pregnant she is usually tested for sexually transmitted infections and will see a doctor throughout the nine months of her pregnancy.

Anatomy also may play a role, Menza said. The tissue in a woman’s vagina is more delicate and more prone to damage. Women also don’t have as many visible symptoms of an STI as men do.

There are multiple reasons for the increase in STI rates, Menza said. Since the Affordable Care Act passed in 2014, more people have access to healthcare, which means more people are getting tested.

People also are having more unprotected sex, he said, possibly because the risk of getting HIV and developing AIDS has been reduced through new drugs that can suppress the transmission of the virus and allow people who have the virus to live longer.

“Once new drugs and therapies for HIV came out in 1996, people started living again, which means they started having sex again,” Menza said.

And people aren’t getting tested, Luedtke said. Because the symptoms for many STIs are very slight or mild, a person may not know they have an STI.

For example, the first stage of a syphilis infection is an ulcer near the genitals that often disappears after a few days, Luedtke said. At first a person might be concerned but when the ulcer disappears they might think whatever caused it has gone away.

But in reality, the syphilis infection has moved deeper into the person’s body and is no longer causing a visible sign of the infection, he said. That can lull a person into thinking that they don’t have a STI and as a result they may pass the infection on to a partner, who may pass it on to someone else.

Some people who suspect they may have a STI may be too embarrassed to go to their doctor to get symptoms checked, Luedtke said. As well, some people may not have the money to pay for testing or don't want their primary physician to know they've contracted a STI. But there are several local clinics including Lane County Public Health, Planned Parenthood and HIV Alliance that offer free or reduced STI testing.

The only way to know for sure is to get tested, Menza said.

Testing recommendations

Current testing guidelines may not be frequent enough for people who very sexually active and have multiple partners, said Menza.

The CDC recommends annual testing for sexually active adults between 15-24 years old, all pregnant women and at least once in a lifetime for HIV for persons between the ages of 13 and 64, Menza said.

Untreated STIs can cause significant health problems, especially for women, Menza said. Women with untreated chlamydia or gonorrhea infections can develop pelvic inflammatory disease, which is a major cause of infertility, ectopic pregnancy and chronic pelvic pain. An ectopic pregnancy occurs when a fertilized egg embeds in a woman's fallopian tubes or outside of her uterus.

Pregnant women can pass chlamydia and syphilis on to their child during delivery. Chlamydia can cause blindness and pneumonia in a baby.

Syphilis can result in stillbirth or death of the infant or lifelong developmental problems for a child, Luedtke said.

The number of babies contracting syphilis at birth is especially worrisome to public health officials. According to the CDC, nationwide “reported cases (of congenital syphilis) jumped from 362 in 2013 to 918 in 2017 — the highest number of recorded cases in 20 years.”

In Oregon, cases of congenital syphilis rose from two in 2007 to eight in 2017. In Lane County, there has been only one case of congenital syphilis since 2008.

“For nearly 10 years we didn’t see babies with syphilis,” Luedtke said.

In men, an untreated infection can lead to infertility, an increased risk of getting HIV and scarring of the urethra and prostate, which can lead to difficulties urinating.

All of these infections can be treated and cured with a week or two of antibiotics or prevented with a vaccine, Luedtke said. They also can be prevented by using a condom during sex.